[MCOH-EH] [Bulk] Ebola infected HCW

[Vaughn, Andrew I., M.D., M.P.H.]

I note that Mt. Sinai prefers the WHO approach to doffing PPE (see http://online.wsj.com/articles/new-york-health-system-opts-for-who-ebola-protocol-1413145347 and
http://www.who.int/csr/disease/ebola/remove_ppequipment.pdf )

With regard to the presumed, unknown "protocol breach" that led to a nurse getting infected in Dallas, a recent news item said that the CDC isn't considering a respiratory route of infection because PAPRs were in use during aerosol-generating care. It would be good to know if/when the PAPR had last been flow-checked. The devices to do so are cheap ($25), and can identify clogged filters, weak/underpowered batteries, and other issues that may compromise effectiveness. PAPRS are certainly convenient, but their intrinsic complexity requires more care and attention than an N95.

- Andrew


Andrew Vaughn, MD MPH
Medical Director, Occupational & Environmental Safety
Mayo Clinic, Rochester MN
vaughn.andrew at mayo.edu

From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Kathy Dayvault
Sent: Tuesday, October 14, 2014 9:39 AM
To: 'MCOH/EH'
Subject: Re: [MCOH-EH] [Bulk] Ebola infected HCW

Coming from a manufacturing environment it was hard to folks to look beyond worker failure as the source of the problem. When you create a safety culture, you look for the root cause of the issue.

I agree with you...removing gloves first seems problematic. Back in the 70's the disposable gowns had ties that were not easily torn in the institution that I worked in.

The thought is the back of the gown is less likely to be contaminated than the other parts and you wanted to keep contaminated gloves away from the skin while untying the gown.

With new emerging infectious diseases and easier gown design, it seems it is not necessary to remove gloves first unless soiled. For me personally, double gloving reduces dexterity.

I think we should look at design of isolation protection ( gowns, gloves, etc.)  and best practices...is it possible to have a decontamination area or other processes that reduce contamination and transmission?

Just some thoughts.....

Kathy Dayvault RN, BSN, MPH, COHN-S/CM
JET Consulting
Independent Occupational Health Nurse Consultant
Kdayvault11 at att.net<mailto:Kdayvault11 at att.net>

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